Expert Answers on Complementary Therapies for Chronic Pain

Robert Bonakdar, MD, is the director of pain management at the Scripps Center for Integrative Medicine in San Diego.

Q:How many people with chronic pain use complementary remedies?

A:Surveys show that 40% or more of chronic pain patients use some level of complementary therapies. The number is high because pain is becoming epidemic. More people are experiencing pain, so you are going to have people who dont get immediate relief and start searching for other options. According to several large surveys done by the National Institutes of Health, the needs of the pain patient arent always being met. So it makes sense that pain patients will ask, "What else is out there?"

The most common treatments are manual therapies, such as massage or chiropractic, as well as herbal medicine, dietary supplements, acupuncture, and mind/body therapies (a catchall phrase for techniques like biofeedback, guided imagery, and meditation).

A:Yes, within reason. There are obviously many approaches that fall under that umbrella. Most of them are benign treatmentsyou arent going to necessarily mess anything up by doing them. My advice is always to use a health-care advocate like a doctor who can give you unbiased treatment advice. If you are getting to a point where other things arent working, most rational health-care providers will bring up other options. But we need a larger knowledge base84% of doctors feel uncomfortable discussing complementary and alternative medicine (CAM). When probed, they say that they dont know enough about it.

Q:How do the mind and body interact when you're in pain?

A:We know pain can create very significant emotional and physical stress in the body. The stress component can cause a large cascade of stress hormones that go on to damage other parts of the body and place a huge burden on the brain. The brain literally changes from pain; the brain actually will lose part of the gray matter so you have a less functional brain. You also have more depression, more insomnia, and more anxietythe nervous system becomes its own enemy. Mind/body therapies are an elegant avenue to retrain the brain, and one is not necessarily better than another. They are all shifting the mind to a better place. It might not take your back pain away tomorrow, but it can give you excellent coping strategies and increase awareness of what modifies the pain.

A:It's not a one-size-fits-all approach. It depends on what you are looking for and what you are open to. If you are stressed out and want something relaxing, you might try guided imagery or hypnosis for pain. If you are very data-driven or analytical, you can try biofeedback. Yoga is great for back pain, but one has to be open to the concept and the level of investment that may be required to see results. CAM is much like medication; you have to try different things until you find something that works.

Q:How can I tell the difference between valid, effective treatments and miracle cures that could be dangerous?

A:Anytime that someone is in a bad state of health, they may become desperate for relief. In some cases, people will try to take advantage of that scenario. So you need to have a health-care advocate to help you filter out all of the information. The best person to do that is a health-care provider or someone you trust, in the context of that experience. You can find a lot of information about valid treatments at the National Center for Complementary and Alternative Medicine.

Q:What is the most important new research on CAM therapies?

A:There is a lot of interest in research using functional MRI to show how acupuncture changes the brain. This is proving what they knew 3,000 years ago, that a needle between the first and second finger can help decrease pain; now we know it may be because it makes the limbic system less sensitive. There is also research on the effects of biofeedback and chronic pain, particularly fibromyalgia, irritable bowel syndrome, and recurrent abdominal pain. Another type of biofeedback being studied is heart-rate variability, a noninvasive way to look at how stressed someone is; low heart rate variability when the heart is slow to adjust its rate in response to changing situationsis linked to high pain, high anxiety, and increased rate of heart disease.

Q:Do you think complementary approaches will soon be part of mainstream pain treatment?

A:In most of the world, people have some sort of CAM integrated into their treatment. Unfortunately, the United States is behind. We need more education and more basic efficacy research to show, for example, that a chronic pain patient feels better after 12 weeks of acupuncture. We are getting there, but its slow.

Q:What can I do if my doctor is resistant to incorporating complementary approaches?

A:Each patient owes it to herself to create the optimal health-care environment, which includes the doctor, the clinic, and the staff. Sometimes you have to find a different provider. You have to find someone you can work with, in terms of personality and the dialogue, and teasing that out is important.

Q:How can I find a good CAM practitioner?

A:Start by asking your doctor if he can recommend someone who works with CAM. If that doesnt work, then go to a national or state licensing organization for whatever you are interested in, acupuncture or massage, for example. Pick a few names, call the providers, and make sure that everyone is on the same page. But again, make sure that you have a pain advocate who can advise you. They might tell you that a particular treatment isnt good for you if you just started a new medication. There are ways now that providers can communicate, such as with electronic medical records, to make it a little bit easier. Remember, you shouldnt be your own quarterback. You shouldnt be riding the bike while you are trying to fix it.